Provider Demographics
NPI:1679575948
Name:CAROTHERS, GARY G (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:CAROTHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 631662
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1662
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:7730 MONTGOMERY RD STE 120
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4284
Practice Address - Country:US
Practice Address - Phone:513-791-5999
Practice Address - Fax:513-791-4567
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.028347207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0213183Medicaid
180021895OtherMEDICARE RAILROAD
KY64010390Medicaid
OH0373107Medicare PIN
OH0373108Medicare PIN
180021895OtherMEDICARE RAILROAD